gms | German Medical Science

Objective: In contrast to glioma surgery, the value of radiologically complete resection and the use of surgical adjuncts to optimize the extent of resection are not well established for patients with cerebral metastases (CM). Our aim was to report on the outcome of patients undergoing intended complete resection of CM using intraoperative MRI guidance.

Method: Retrospective analysis of our prospectively collected database of patients undergoing resection of a histopathologically proven CM with the use of an intraoperative MRI.

Results: 18 patients were included in this analysis. The mean age was 65 years. Median follow-up was 16.7 months. All patients were in good clinical condition (EGOG 0 and 1) and harbored single CM. In three patients (16.7%), iMRI revealed residual contrast-enhancing tissue when tumor resection was thought to be complete. In all three cases, this tissue was resected and was found to be infiltrative tumor on histopathological assessment. In four patients, 5-ALA was also used, but only one of these tumors (25%) exhibited red fluorescence under blue light. Early postoperative MRI confirmed complete resection of contrast-enhancing tissue in all patients (100%). Kaplan Meier analysis rendered a median overall survival following CM resection of 22.6 months (95%-CI: 4.1–41.2).

Conclusions: CMs are not encapsulated, but infiltratively growing tumors. Therefore, intraoperative MRI as a surgical adjunct enhances completeness of tumor resection. Aggressive surgical treatment of single CMs appears to lead to a survival benefit.